Provider Demographics
NPI:1356749576
Name:WELMON, ASHLEY (MOTR/L, CLC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WELMON
Suffix:
Gender:F
Credentials:MOTR/L, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GINGER CREEK VLG
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3517
Mailing Address - Country:US
Mailing Address - Phone:618-656-7157
Mailing Address - Fax:
Practice Address - Street 1:7 GINGER CREEK VLG
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3517
Practice Address - Country:US
Practice Address - Phone:618-656-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILALPP-208865174N00000X
IL056.010538225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN